Wiki Is a 'PR' denial required to bill secondary insurance?

[sjurisch]

I work for a DME company and we often have times where the primary insurance does not consider the equipment reasonable and necessary, but the secondary plan will pay for it. We get the proper waiver on file to bill, but we often have a hard time getting the primary to deny with a PR denial code. Technically, we aren't trying to bill the patient - we simpley want to bypass the primary and bill the secondary payer. In these cases, is it appropriate to drop the balance to secondary when the primary denies with a CO code or is it required to have a PR denial?

 

[vanessamoldovan]

I work for a DME company and we often have times where the primary insurance does not consider the equipment reasonable and necessary, but the secondary plan will pay for it. We get the proper waiver on file to bill, but we often have a hard time getting the primary to deny with a PR denial code. Technically, we aren't trying to bill the patient - we simpley want to bypass the primary and bill the secondary payer. In these cases, is it appropriate to drop the balance to secondary when the primary denies with a CO code or is it required to have a PR denial?

Hello! Yes, it is appropriate to send a CO denial to the secondary. Have you tried this before? You are welcome to email me at vanessamoldovan.rcm@gmail.com if you would like to continue this conversation.

 

[sjurisch]

Thank you! We have done this (on accident) and the secondary companies do pay most of the time. I just wanted confirmation this is acceptable continue going forward. Thanks again!

 

[shanpiech]

It will depend on the payer. This may be monitored more closely depending the payor you are working with.